The Vanderbilt Center for Education and Research on Therapeutics (CERT) is proposed as part of a national collaboration to systematically improve therapeutics. Our theme is Promoting Optimal Pharmacotherapy in Medicaid and Veterans'Health Administration Populations. These populations are our focus because of vulnerability to suboptimal therapeutics, over-representation of populations and high cost diseases that are priorities for AHRQ and other stakeholder federal agencies, and availability of automated databases. Vulnerable groups encompassed by the CERT focus include the developing fetus, young children, low-income mothers, African-Americans and other minorities, persons with mental and somatic disabilities, the chronically ill, the elderly, and persons in nursing homes. Within these populations, we will conduct multi-disciplinary research and education programs with our partners that will: 1. Fill critical gaps in the knowledge base through carefully selected studies of drug effects; 2. Optimize therapy by identifying suboptimal practices and conducting educational programs; 3. Evaluate potentially counterproductive policies. Our sub-theme is Reducing the Occurrence of Medication-Related Gastropathy, an important disease that is a priority for AHRQ and other federal agencies and with which we have substantial prior experience. The proposed new CERTs continues the work of an existing multi-disciplinary CERTs that has completed 63 projects and generated 50 publications to date, including 7 in The New England Journal of Medicine, 3 in Lancet, and 2 in JAMA. It has established strong partnerships with Tennessee Medicaid, the State Department of Health, the VA Tennessee Valley Healthcare System and Geriatric Research, Education and Clinical Center, the Food and Drug Administration, and the NIH. We propose 8 new projects. Four are of drug effects--1) SSRIs and birth defects, 2) ADHD drugs and adverse cardiovascular events, 3) Medications and sudden death, 4) Warfarin and antimicrobial interactions;three are educational programs-5) Improving use of therapy to prevent stroke/sepsis in children with sickle cell disease, 6) Improving gastroprotection in high-risk VA NSAID users;7) Improving gastroprotection in high-risk Medicaid NSAID users;and one is a policy evaluation-8) Effect of Medicaid disenrollment for patients with serious mental illness. These projects are tightly linked to our theme/sub-theme and have the potential to materially improve clinical practice in highly vulnerable populations that often are under-represented in other research programs.